AccountId: 011433970860
ContactId: c46da8ab-d164-4ab2-b382-cfbd5fbe4088
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 640979 ms
Total Talk Time (AGENT): 118367 ms
Total Talk Time (CUSTOMER): 194401 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/c46da8ab-d164-4ab2-b382-cfbd5fbe4088_20250424T16:11_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in um customer service. I have a provider on the phone. His name is [PII].
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] And he is calling claim status for policy number 2486015.
[AGENT][POSITIVE] OK, thank you. I can take care of them.
[CUSTOMER][NEUTRAL] Alright, OK, um, I verify the date of birth and the address. The date of service on the claim is if you want it is [PII].
[CUSTOMER][NEUTRAL] And the amount is $29.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, perfect. Thank you so much.
[CUSTOMER][POSITIVE] Thank you, dear. Have a good day.
[AGENT][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Hello, this is [PII] on the care team. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII], and I need uh claim status for patient.
[AGENT][NEUTRAL] OK, and what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] Date of service is [PII] and bill amount is $29.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, it looks like we received that claim on
[AGENT][NEUTRAL] One moment. That was received on 11-7-2024.
[AGENT][NEUTRAL] Process [PII].
[AGENT][NEUTRAL] The calendar year maximum was meant for the year.
[CUSTOMER][NEUTRAL] OK. So claim is denied, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] And may I know what is the yearly maximum limit for this?
[AGENT][NEUTRAL] Um, let me look.
[AGENT][NEUTRAL] It's 500.
[CUSTOMER][NEUTRAL] 500. And may I know what is the last date of service on which uh this patient is paid?
[AGENT][NEUTRAL] Um, I, I can only give you information on the claim you're asking about. So for this claim, the maximum was met.
[CUSTOMER][NEUTRAL] OK. And uh for this current claim, uh may I know is there any patient responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] OK. And please provide me claim number.
[AGENT][NEUTRAL] Um, that claim number is 353-0941.
[CUSTOMER][NEUTRAL] OK. And please send this UV on our fax. I'm providing you fax number.
[AGENT][NEUTRAL] OK, what's your facts?
[CUSTOMER][NEUTRAL] It is 615-691.
[CUSTOMER][NEUTRAL] 6205.
[AGENT][POSITIVE] OK, I'll get that faxed over. It just takes about 5 minutes. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] OK. And please
[CUSTOMER][NEUTRAL] Yeah, please spell your name for me.
[AGENT][NEUTRAL] Um my name is [PII]
[CUSTOMER][POSITIVE] OK. And I'm having one more uh patient. Can you help me with that too?
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, sorry, just one more moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. So next policy number is 019925272.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Will you repeat that again? I think it was too many numbers. What was that?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It is 01.
[CUSTOMER][NEUTRAL] 99
[CUSTOMER][NEUTRAL] 25
[CUSTOMER][NEUTRAL] 272.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I'm not pulling anything up under that number. What was the last name?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Last name is [PII]. Uh, I spell. It is [PII].
[AGENT][NEUTRAL] And first name?
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm pulling that up. One moment.
[CUSTOMER][NEUTRAL] And the.
[AGENT][NEUTRAL] Is this for a dental policy or?
[CUSTOMER][NEUTRAL] Dental, dental.
[AGENT][NEUTRAL] Do you have the last 4 of the social?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, I'm not having social, but I can provide you date of er uh sorry, uh, birth, date of birth.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, hold on just a second.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. What was the date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm still trying to search. I don't, um, let me see.
[CUSTOMER][NEUTRAL] The menu.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm not pulling anybody up with that name and date of birth and the information you provided.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. No issues, uh,
[CUSTOMER][NEUTRAL] I'll check by myself.
[CUSTOMER][POSITIVE] OK, then, uh, thank you. Thanks for your help today. And one more thing, uh one.
[AGENT][POSITIVE] OK, thank you for calling APL. You have a great.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, you sent, you sent you already, right?
[AGENT][NEUTRAL] I did. I'm checking to see if it.
[AGENT][NEUTRAL] Went through.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Yes, I did send it and let me see.
[AGENT][NEUTRAL] I don't have a confirmation yet, but I did send it so it might just be a few more minutes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, then, no issues. Thank you.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Great day. Bye-bye.